Sophia Ragan, CCC-SLP
Individual provider Active NPI Speech-Language Pathologist · Brooklawn, NJ
NPI 1316767288 · NPPES record last updated Oct 16, 2024
Key facts
- NPI
- 1316767288
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- License
- SL016600 (PA)
- Practice address
- 159 Lake Dr
Brooklawn, NJ 08030-2664 - Phone
- (609) 816-2315
- NPI assigned
- Oct 15, 2024
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SL016600 | PA | MD | Speech-Language Pathologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | SL016600 | PA | Yes |
Addresses
Primary practice location
159 Lake Dr
Brooklawn, NJ 08030-2664
Mailing address
159 Lake Dr
Brooklawn, NJ 08030-2664
Phone (609) 816-2315
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All providers in Brooklawn, NJ · Speech-Language Pathologist in New Jersey
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 16, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.